Group A Streptococcus necrotising myositis of the limbs secondary to cavitating pneumonia

Abstract

Necrotising myositis is a rare complication of Group A Streptococcus infection requiring early and aggressive surgical management to prevent mortality. However, early diagnosis is difficult due to non-specific initial presentation and a low index of clinical suspicion given the paucity of cases. We highlight these challenges and present a case of a 22-year-old woman presenting with cough, fever and severe limb pain refractory to analgesia during the COVID-19 pandemic. We outline potential confounding factors that can delay intervention and offer diagnostic tools that can aid clinical diagnosis of necrotising myositis. In reporting this case, we hope to raise awareness among clinicians to avoid these pitfalls.

Limb presentations of invasive Group A Streptococci infection in children

“… 2 However, in rare cases it can become invasive, leading to systemic bacteremia and life-threatening sepsis. 3 Invasive GAS is associated with skin and bone infections including cellulitis, septic arthritis, myositis, and necrotising fasciitis. 4 …”